Since Texas Children’s Hospital West Campus opened almost four years ago, it has become one of the most active pediatric hospitals in the Houston area, and all indications point toward continued growth.
To keep meeting the steady increase in demand and community growth, Chanda Cashen Chacón, West Campus’ new leader, recently announced an aggressive capital improvement project. The project, approved by Texas Children’s Board of Directors, will cost an estimated $50 million and will focus on three key areas – inpatient capacity, ambulatory capacity and supporting hospital infrastructure.
“At the West Campus we are dedicated to the patients and families we serve, the process in which we serve them and our overall outcome,” Chacón said. “To accomplish all three of these things well, we need to continue to expand the facility that allows us to further our commitment to the community. This capital expansion project will ensure that promise continues.”
The first phase of the project includes a $16 million, 18-bed expansion of the hospital’s acute care capacity. The new unit will include an eight-bed special isolation unit designed for children with highly contagious infectious diseases, such as pandemic influenza, entervirus D68, Ebola and many others. The design for the acute care and special isolation unit is in the approval process and construction is anticipated to begin in May. The unit should be up and running by October.
“This unique unit will be an indispensable resource to our local community, Texas and our region,” Chacón said. “Taking care of some of the sickest children in our hospital system is one of our top priorities.”
In addition to the new acute care and special isolation units, the first phase of the capital project will include the following five projects, which are estimated to cost $6.9 million and be completed by the end of the year:
Create dedicated suite for Interventional Radiology services
Design shell space for OR/PACU expansion
Convert 13 offices within existing clinics into clinic exam space
Build office and administrative support space for dedicated physicians and providers
The second phase of the capital improvement project will include the following four projects, which are estimated to cost $27.1 million and be completed by the end of 2017:
Build additional 24 acute-care beds
Build four additional operating rooms and expand pre-operative and post-operative areas
Equip all beds in critical care unit
Expand clinics to support OR expansion
“Most of these projects are in the design phase or will be soon,” Chacón said. “We look forward to continuing to serve our patients and families.”
February 24, 2015
During the early morning hours of February 17, Elysse Mata sat holding her babies tightly, kissing them as tears ran down her face. She was saying goodbye to her girls, conjoined for the last time before undergoing a historical surgery that would offer them their first chance at separate lives.
“We’ve been waiting for this moment for a year,” Elysse said. “Ever since we found out the twins were conjoined, we’ve been praying and hoping this day would come.”
Conjoined twins Knatalye Hope and Adeline Faith Mata – known by their family simply as Hope and Faith – were born at Texas Children’s Pavilion for Women on April 11, 2014 via Caesarean-section at 31 weeks gestation after weeks of extensive prenatal imaging, multidisciplinary consultation and planning at Texas Children’s Fetal Center. The babies each weighed 3 pounds, 7 ounces.
Surgeons allowed the girls to grow and gain strength for 10 months before undertaking the difficult task of separating them. During that time our comprehensive team of surgeons, physicians, nurses and support staff prepared for the day that had finally arrived. The lead surgeons had met and thoughtfully examined every aspect of their procedure, the simulation staff prepared the team for complications, and Critical Care nurses were readying the PICU for the girls post-surgery.
Letting go
In those quiet, prayerful moments before the surgery, Elysse’s husband, John Eric, and their 5-year-old son, Azariah, were also near, kissing the girls’ foreheads and squeezing their tiny hands while they anxiously awaited the start of the surgery that would change the girls’ lives forever. A group of extended family, friends and a Texas Children’s Hospital chaplain joined the Matas for an emotional prayer.
Lead surgeon Dr. Darrell Cass entered the room, gave the family a hug, and with the help of supporting operating room staff, escorted the girls to Texas Children’s Operating Room 12. Members of the girls’ NICU care team, who had been by their sides for almost a year, lined the hallways in an emotional show of support.
Just after 7 a.m., Hope and Faith were wheeled into the operating room where a team of 12 surgeons from seven specialties, six anesthesiologists, eight highly trained nurses and support staff spent nearly 24 hours performing an operation that would eventually separate the twins.
Surgery begins
During the first few hours of the procedure, Anesthesiologist Dr. Helana Karlberg and Surgical Nurse Audra Rushing prepped the girls for surgery. At 1:10 p.m., Chief of Plastic Surgery Dr. Larry Hollier made the first incision. For the next 18 hours, the surgical team worked in shifts to separate the twins, who shared a chest wall, pericardial sac (the lining of the heart), diaphragm, liver, intestines, bladder, uterus and pelvis.
As the surgeons continued the difficult task, family and friends gathered in a large, room praying and supporting the parents while they waited for updates from the surgical team.
“This is the (most difficult) feeling ever,” said John Eric Mata as he and Elysse waited for their first in-person update. “It’s giving me too much time to think. I’ll be a lot more comfortable when they say they are separated. I’m ready for that.”
At one point, the family was told there had been a rocky part in the procedure when the twin’s livers were being operated on. During that process, surgeons explained there was quite a bit of blood loss and that the anesthesiologists and cardiologist in the room had to keep up with that and maintain the girls’ blood pressure.
“At times it was difficult,” Hollier said. “But it was controlled very rapidly, allowing us to move on with the procedure.”
Hours later, Eric and Elysse heard the answer to months of prayers when Pediatric Surgeon Dr. Oluyinka Olutoye met them in a private consult room and delivered the good news – the twins had been successfully separated.
“This is the farthest they’ve been from each other,” Olutoye said when we greeted the family around 1 a.m. “They’re about 30 feet apart right now.”
They are two
Separate for the first time, the twins were taken to different operating rooms where surgeons continued to work on the girls’ critical organs. Just before 10 a.m., the surgery was complete, and the family visited their girls, apart for the first time in rooms next to each other in the PICU, where they are being cared for by a team of their NICU primary nurses and their new PICU nurses.
Elysse said she and her family are extremely grateful for the team that separated her babies, and the countless hours they put into understanding the girls’ condition, and how best to treat and care for them.
Cass and several of the other surgeons, including plastic surgeon Dr. Ed Buchanan, met the family in Adeline’s room to share in the family’s joy and relief. They gave the family a summary of the monumental procedure and explained what they should expect in the next few days.
“Thank you for your trust,” Cass said to the Mata family. “We are going to keep doing everything we can to get them through this. So far, so good.”
Hollier said that to the best we know this is the first time a case of this magnitude – conjoined twins connected at the chest, abdomen and pelvis – has ever been done.
“It could not have gone better,” he said. “It was phenomenal team work and great preparation on the part of the institution.”
Click on the photo to view a gallery showing the Mata’s journey to separation.
A dream realized
By late morning Wednesday, February 19, Elysse and John Eric were again with their babies, watching over their girls, now in two beds, in adjoining PICU rooms. It was a moment they had been waiting for since more than a year ago when a routine ultrasound revealed that Elysse was carrying conjoined twins. They traveled from their hometown of Lubbock to Texas Children’s Fetal Center, where the next chapter of their journey began.
Today, their family has a promising new chapter, thanks to the compassionate expertise of our physicians, nurses and countless staff and employees.
“We love them,” Elysse said of the girls’ medical team. “They mean the world to us, and they will forever hold a special place in our hearts.”
Conjoined Twins Separation Surgical Team
Plastic Surgeon Dr. Ed Buchanan
Lead Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Darrell Cass
Chief of Pediatric Gynecology Dr. Jennifer Dietrich
Pediatric Urologist Dr. Patricio Gargollo
Transplant Services Surgeon Dr. John Goss
Anesthesiologist Dr. Kalyani Govindan
Chief of Plastic Surgery Dr. Larry Hollier
Lead Anesthesiologist Dr. Helena Karlberg
Plastic Surgeon Dr. David Khechoyan
Pediatric Urologist Dr. Chester Koh
Cardiovascular Surgeon Dr. Dean McKenzie
Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Oluyinka Olutoye
Have you ever wondered why life leads us down certain career paths? For Dr. Ruth Ann Luna, the answer is obvious – her immense curiosity and passion for research to improve the quality of life for sick children.
As director of medical metagenomics at Texas Children’s Microbiome Center, Luna focuses much of her research on the link between disturbances in the gut microbiome – bacterial communities in the gastrointestinal (GI) tract – and GI symptoms in children.
Her quest for answers goes far beyond her role as an astute scientist. One of her biggest motivators is her 6-year-old son, Kellen, who has autism accompanied by significant GI problems – a common complaint among children with autism spectrum disorders.
“When Autism Speaks announced its GI and Neurobehavioral Processes grant almost a year ago, I recognized it as the opportunity of a lifetime,” said Luna, an assistant professor of pathology at Baylor College of Medicine. “I was in awe when I found out we were awarded this funding to advance autism research.”
With the support of a $1.4 million, three-year grant, Luna and her colleagues at Texas Children’s and Baylor will embark on a comprehensive, multi-center study to determine if a biological connection exists between autism and GI disorders.
“Previous research has shown that gastrointestinal problems are more common among individuals with autism and may worsen behavioral problems,” said Texas Children’s Pathologist-in-Chief Dr. James Versalovic, the Milton J. Finegold professor of pathology at Baylor and director of Texas Children’s Microbiome Center.
Co-led by Luna and Versalovic, scientists in the Microbiome Center will evaluate behavior, GI symptoms, the microbiome and the metabolome, all in the hopes of identifying biomarkers of abdominal pain, understanding the impact of the gut-brain-microbiome axis and determining metabolic disturbances in autism.
“There are inherent differences in the guts of children with autism,” Luna said. “By analyzing all of these factors, we hope to develop better ways to diagnose and treat gastrointestinal issues in children with autism.”
The autism study will enroll 375 children ages 4 through 12 at Texas Children’s, the University of Texas Southwestern Medical Center in Dallas and Nationwide Children’s Hospital in Columbus, Ohio.
Children with autism – with and without GI symptoms – and their unaffected siblings, and children without autism, with and without GI symptoms, are currently being recruited for the study.
“The data gleaned from our research will benefit my son and other families who have children with autism, especially those children with limited verbal abilities” Luna said. “This amazing opportunity to positively impact lives is what makes my job extremely fulfilling.”
For more information or to enroll in the Microbiome Center’s autism and GI study, contact Luna at Ext. 4-1894 or raluna@texaschildrens.org.
Texas Children’s Mobile Clinics are now equipped with EPIC, allowing medical staff to offer a more thorough continuum of care.
“We aim to find medical homes for all our families,” said Dr. Sanghamitra Misra, medical director of the Texas Children’s Mobile Clinic Program. “Now that we are entering our clinic notes into EPIC, any practitioner within the Texas Children’s system can read our notes to understand a patient’s history and diagnoses. This provides continuity of care that we have never had before.”
As a result, follow-up care, even if it takes place in the emergency room, can be more coordinated. With a simple keyboard stroke, medical staff organization-wide can access information about patients treated at the mobile clinics. In turn, staff at the mobile clinics can track their patients’ follow-up care.
“We often care for children on the mobile clinics who suffer from chronic illnesses and need follow-up care,” Misra said. “With Epic, we can more easily get them into a medical home and, if needed, a referral to a Texas Children’s specialist.
Texas Children’s Pediatric President Kay Tittle said the move to putting the mobile clinics on EPIC is a positive one that will provide better documentation of the patients seen through the Mobile Clinic Program.
“Our patients will benefit from it and so will our medical staff,” Tittle said. “It’s a win-win for everyone involved.”
During the school year, the Super Kids Mobile Clinic travels primarily to Houston Independent School District schools, community centers and churches in the Southwest Gulfton area. The Ronald McDonald Care Mobile travels primarily to HISD schools, community centers and churches in the Southeast Hobby area.
The clinic provides free vaccinations to those who qualify for the Texas Vaccines for Children program and also provides free well child visits, sick visits and hearing or vision screenings for uninsured children in the Houston area. In addition, both mobile clinics have pharmacies that are stocked with common medications. The providers can perform common laboratory tests. Lastly, providers and staff members educate all patients coming through the clinic about the different insurance options available to them.
In the summer, the clinics travel throughout the Houston area and sometimes even further to provide free vaccines to children before the school year starts.
February 17, 2015
Around 100 BC acupuncture simulation was used and recorded in China. The long history of simulation has helped health care workers learn difficult procedures and manage high risk or complex patient care situations before they’re done on actual patients. It’s a sort of “practice” for real life situations in the clinical world. In 1910 life-like simulators were created. While Texas Children’s has been practicing simulations for many years, five years ago, under the leadership of Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, the simulation center was created. It is a dedicated space in the Feigin Center which gives caregivers a safe space to practice life-like situations with simulators which react just as humans would.
In November, simulation experts from the Center for Medical Simulation (CMS) at Massachusetts General Hospital and Harvard Medical School held a four-day course, the Institute for Medical Simulation (IMS) course, for health care providers interested in or already leading simulation efforts across Texas Children’s. The course is one of the most comprehensive and immersive simulation training programs available and focuses on how to implement best practice simulation for improving quality, patient safety, and education. Four days of theory, practice, and reflective feedback create a truly experiential education where our simulationists develop a strong and comprehensive understanding of how to most effectively use simulation within their departments and educational programs.
“The goal of bringing the IMS course to Texas Children’s is to transform our simulationists to be outstanding simulation educators,” Arnold said.
“This course is a chance to have top experts in the field teach us about debriefing after a simulation exercise,” said Cara Doughty, Emergency Center physician.
Debriefing during or after simulation is singularly the most critical aspect to a successful simulation activity. It is where the learning occurs. Debriefing involves a discussion led by a trained expert reviewing what went right, how each person performed, what should have been done differently and how this situation could be improved in the case of a real-life scenario. It also is the most challenging aspect of implementing simulation, typically debriefing techniques are not instinctive to most healthcare providers and require rigorous practice.
Simulations can take place both at the Simulation Center and in real patient care settings like the operating rooms. Bonnie Eaton, a nurse in the operating rooms, has seen a great benefit with being involved in these courses as well as encouraging more simulations for operating room staff.
“It’s reassuring to the staff to have the ability to practice these scenarios before they are experiencing them with real patients,” said Eaton. “In the ORs, we are trying to develop a program to get all of the staff involved in simulations.”
Arnold has been a major advocate of bringing more simulation training activities to all areas of the hospital. Currently, simulations are done with clinicians from almost every area of the hospital and simulation scenarios have helped the staff prepare for major surgeries like the Mata conjoined twins separation surgery, and even for the possibility of a patient with Ebola visiting the hospital. Simulations play a key role in preparing the staff for these rare cases and helping determine the best course of action.
The simulation experts from CMS come from diverse backgrounds, but all have simulation educational expertise in common. Dan Raemer, PhD, has a background in bioengineering and is an expert in teamwork and crisis resource management. Walter Eppich, MD, Med, is a pediatric emergency medicine physician and is an expert in debriefing and faculty development. Kate Morse, PhD, MSN, RN, is a critical care advanced practice nurse and an expert in interprofessional education.
“Having Drs. Raemer, Eppich, and Morse here really re-energized the overall simulation program at Texas Children’s Hospital,” said Kelly Wallin, assistant director of Texas Children’s Simulation Center. “It is vital that we continue to develop and support a strong expert team of simulationists across the institution so we can implement simulation activities in all patient care areas.”
Not only did the visiting faculty lead a 4 day course for 20 simulationists here at Texas Children’s Hospital, but Dr. Raemer gave two innovative grand round presentations, one to pediatric surgery and the other to pediatrics. Simulation is becoming a more recognized and even standardized quality and safety tool across the nation and even internationally.
“We need to support and develop simulation activities not only to be a leader in quality, safety and education, but also to better serve our patients,” Arnold said. “The simulation center resides within the Quality and Safety Department at Texas Children’s Hospital because we recognize the value of it to patient care outcomes and safety.”
Due to our success in treating the most severe cases of morbidly adherent placenta, Texas Children’s Pavilion for Women continues to attract numerous patients from across the country. With the rise of caesarean births in the U.S., this potentially life-threatening condition is becoming more common among pregnant women.
Morbidly adherent placenta – known as placenta accreta, increta or percreta, depending on the depth of uterine invasion – occurs when the placenta and its blood vessels grow deeply into the wall of the uterus and is unable to detach after childbirth. Women who have had prior caesarean sections (C-sections) or other uterine surgeries are more at risk for this pregnancy complication since the placenta latches on to the surgical scar too firmly. About 5 to 7 percent of women die due to massive hemorrhage.
“The number of women with morbidly adherent placenta that we care for is rapidly escalating as our outcomes continue to attract a growing number of referrals,” said Texas Children’s OB-GYN Chief Dr. Michael Belfort, a world-renowned placenta accreta expert and founder of the Morbidly Adherent Placenta Program at Baylor College of Medicine. “Our success is rooted in our ability to work as a team.”
Women with morbidly adherent placenta receive multidisciplinary care from a diverse group of specialists representing maternal-fetal medicine, gynecologic oncology, anesthesiology, urology, neonatology, radiology and blood bank services.
“Our multidisciplinary team works closely with the hospital’s blood bank to ensure adequate supply of blood products is available for surgery and to help manage transfusions,” said Texas Children’s Maternal-Fetal Medicine specialist Dr. Karin Fox. “We rely on our anesthesiology team to administer blood and draw labs to ensure electrolytes remain stable in addition to keeping the patient comfortable. Urologists provide expertise when the placenta embeds itself into the urinary system.”
The approach that gynecologic oncology surgeons use to remove uterine cancer inspired the technique used to treat placenta percreta since the abnormal placenta acts like a cancer invading the outside of where it is supposed to be growing.
“We take a wider approach when we perform a hysterectomy to reduce the potential for blood loss,” said Texas Children’s gynecologic oncologist and surgeon Dr. Concepcion Diaz-Arrastia. “We remove the uterus and cervix in a modified radical hysterectomy along with a small amount of the tissue that attaches the uterus to the pelvis as if it were cancerous.”
Khadajah Winchester credits the Pavilion for Women’s highly skilled team of physicians who meticulously prepared and planned for her emergency surgery. She was airlifted from a hospital in Alexandria, Louisiana to the Pavilion for Women.
Winchester – who had two previous caesarean deliveries – had placenta percreta where the placenta invaded part of her bladder. Physicians made an incision high on Winchester’s uterus to avoid touching her placenta. Despite minimal bleeding during the actual delivery of her 6-pound 7-ounce baby girl Brooklyn, Winchester began bleeding profusely from the numerous vessels that had fed her invasive placenta and required a 25-pint massive blood transfusion.
“I hardly had blood pumping through my veins and if I had not gone to the Pavilion for Women, I would have died,” Winchester said. “Hospitals in smaller communities don’t carry the large volume of blood that I needed to survive.”
The Pavilion for Women – world renowned for its comprehensive, multidisciplinary care and focus on high-risk pregnancies – has treated 27 cases of placenta accreta in the last 12 months.
“Patients with risk factors for placenta accreta should consult with specialists early – ideally by 24 to 28 weeks of pregnancy,” said Texas Children’s Maternal-Fetal specialist Dr. Alireza Shamshirsaz. “Early diagnosis prior to delivery is crucial to allow time for planning and preparation to enhance the best possible outcomes for mother and baby.”
Click here for more information about Baylor’s Morbidly Adherent Placenta Program at the Pavilion for Women.
February 10, 2015
In less than a month, a multidisciplinary team of surgeons here at Texas Children’s Hospital will embark on what could be a 36-hour procedure to separate 9-month-old conjoined twins, Knatalye Hope and Adeline Faith Mata.
During that time frame, surgeons from 13 subspecialties will conduct a series of well-orchestrated operations on the girls, who share a chest wall, lungs, pericardial sac (the lining of the heart), diaphragm, liver and pelvis. The separation team will start the surgery and the reconstruction team will complete the procedure.
“This is a huge undertaking,” said Dr. Darrell Cass, pediatric surgeon and co-director of Texas Children’s Fetal Center. “There’s been an extensive amount of involvement from many of the departments in the hospital, including radiology.”
With help from a Dallas printing company, Chief of Radiology Research and Cardiac Imaging Dr. Rajesh Krishnamurthy built a 3D model of the twins’ anatomy to help surgeons plan for the girls’ separation. The model was built using a computerized image data set of the twins and a 3D printer.
“It’s very useful for preoperative surgical planning,” Krishnamurthy said of the model. “Especially when it comes to conjoined twins.”
Twins, specifically conjoined twins, tend to have pretty complicated anatomy. In the case of the Mata twins, there is a large part of the body – the chest, the abdomen and the pelvis – that is fused. Having a 3D model of the girls has given surgeons insight into what they are going to encounter.
The model – which goes into a fair degree of detail, including a detachable, transparent liver – has been especially helpful in the planning of the pelvic portion of the surgery, which presents an interesting and challenging anatomical situation in that each girl has her own pelvic organs but each of those organs gets blood supply from each girl.
“We’re going to have to make some real decisions about which bladder goes to which girl, which uterus goes to which girl and which ovaries go to which girl,” Cass said. “That might be the more complex aspect of the operation.”
The 3D model of the twins was created in about a week. The process started with a high-quality computer tomography or CT scan. The image data set was transformed into a 3D segmentation that was color coded and converted into a printable form. That form was sent to Medcad in Dallas where the physical, 3D model was made under the leadership of Dr. Jayanthi Parthasarathy.
In addition to the conjoined twins, 3D modeling at Texas Children’s is regularly done in orthopedic cases, such as in the setting of hip dysplasia or unusual rotational abnormalities of the bone. It’s also used in some congenital heart disease cases and could be used in other areas as well.
“3D modeling is a visual representation of the complexity that surgeons might encounter during a procedure,” Krishnamurthy said. “This is very powerful when you are trying to come up with unique solutions to a particular case.”
Cass said the 3D model is one of many reasons why the Mata twins are at Texas Children’s Hospital.
“The Mata family did their homework,” he said. “They got to know different hospitals and different surgeons and they chose us. We’re incredibly grateful to them for putting their faith and trust in us and we’re very optimistic that we’ve done all the preparation needed to have a very good result.”
Elysse Mata, the twins’ mother, said she is excited about her girls’ upcoming separation.
“I can’t wait to hold two babies and be able to take them home,” she said.
Knatalye and Adeline were born April 11 at Texas Children’s Pavilion for Women. Delivered via Caesarean-section at 31 weeks gestation, the twins each weighed 3 pounds, 7 ounces.
The girls’ parents, Elysse and John Mata, and their 5-year-old brother, Azariah, learned during a routine ultrasound on January 13 that Elysse was carrying twins and they were conjoined. Subsequently, the family was referred from a physician in Lubbock, their hometown, to the Texas Children’s Fetal Center where they underwent extensive prenatal imaging, multidisciplinary consultation and development of plans to achieve a safe delivery and postnatal care.
Now 9 months old, the babies are doing well as they continue to be cared for by a team of specialists in the Level IV Neonatal Intensive Care Unit at Texas Children’s Hospital.
The first phase of the project includes a $16 million, 18-bed expansion of the hospital’s acute care capacity. The new unit will include an eight-bed special isolation unit designed for children with highly contagious infectious diseases, such as pandemic influenza, entervirus D68, Ebola and many others. The design for the acute care and special isolation unit is in the approval process and construction is anticipated to begin in May. The unit should be up and running by October.
“When Autism Speaks announced its GI and Neurobehavioral Processes grant almost a year ago, I recognized it as the opportunity of a lifetime,” said Luna, an assistant professor of pathology at Baylor College of Medicine. “I was in awe when I found out we were awarded this funding to advance autism research.”
